Benefits of a systematic approach in the evaluation of fetal facial 3-dimensional volumes.

OBJECTIVES: The purpose of our study was to evaluate the accuracy and efficacy of using a systematic approach to teach maternal-fetal medicine physicians how to display a diagnostic fetal profile and palate using 3-dimensional ultrasonography (3DUS). METHODS: Ten maternal-fetal medicine physicians were randomly assigned to 2 groups, A and B, and instructed on basic principles of 3DUS volume manipulation. Physicians in group A were asked to display the fetal profile in 5 volumes, including 1 fetus with abnormalities. Physicians in Group B were asked to display the fetal profile in the same 5 volumes after detailed instruction. The groups were combined, and detailed instruction was repeated. The physicians were asked to review an additional 5 volumes. In a separate session, the physicians were divided into their respective groups, and a similar exercise was repeated. This time, they were asked to display the fetal palate in 3-orthogonal-plane and parallel-plane images. The time required for manipulation was recorded. Images were reviewed for accuracy and clinical utility by 2 blinded experienced sonologists. Data were analyzed with mixed effects models. RESULTS: Fetal profile and parallel-plane palate scores were significantly higher in group B (P < .001) compared to group A. There was no difference between groups in displaying the 3-orthogonal-plane image of the palate or after additional training for either group. The mean times for display did not differ between the groups. The time required for evaluation of the abnormal profiles was longer (P = .02) than that for evaluation of the normal profiles. CONCLUSIONS: Detailed instruction in obtaining 3DUS images of fetal profiles and palates improved the image quality obtained by physicians. Teaching physicians in a standardized way may help improve the use of 3DUS in clinical practice.

Three-dimensional ultrasonographic depiction of fetal abdominal blood vessels.

OBJECTIVE: The purpose of this study was to identify fetal abdominal vasculature with 3-dimensional (3D) ultrasonography and to describe a systematic method for analysis of volume data sets. METHODS: Three-dimensional volumes of the fetal abdomen were acquired prospectively in 30 patients between 15 and 34 weeks' gestation with color Doppler, high-definition (HD) flow, power Doppler, and B-flow imaging. All volumes were analyzed offline by 2 examiners separately. The feasibility of identifying the fetal abdominal blood vessels was analyzed. A standardized approach was applied to identify specific vessels by correlating the images with known anatomic landmarks. RESULTS: The volumes were rotated into an anatomic orientation in the multiplanar mode, and then the vessels were identified in the following order: aorta (30 of 30), celiac trunk (29 of 30), superior mesenteric vein (28 of 30 and 26 of 30 for readers 1 and 2, respectively), superior mesenteric artery (29 of 30), left renal artery (25 of 30 and 26 of 30), right renal artery (27 of 30), common iliac arteries (30 of 30), umbilical arteries (26 of 27), external iliac arteries (20 of 22), umbilical vein (29 of 30), ductus venosus (30 of 30), hepatic vein (29 of 30), right portal vein (29 of 30), inferior vena cava (28 of 30), adrenal artery (2 of 30), hepatic artery (24 of 30 and 23 of 30), splenic artery (24 of 30 and 23 of 30), gastric artery (14 of 30 and 9 of 30), splenic vein (19 of 30 and 15 of 30), and renal vein (1 of 30). A step-by-step systematic approach to identify the abdominal vasculature from the ultrasonographic volume data set was developed. CONCLUSIONS: Fetal abdominal vessels can be easily visualized when a systematic analysis is performed on 3D data set volumes. Visualization of the vessels was optimal when volumes were acquired with HD flow imaging.